Pain physician
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Control of chronic pain and mainly the partial or complete loss of response to analgesics is a major unmet need. Multiple mechanisms underline the development of tolerance to analgesics in general and specifically to opioids. The autonomic nervous system (ANS) plays a role in the development of analgesic tolerance and chronobiology. ⋯ The described variability-based system may ensure prolonged effects of analgesics while reducing the toxicity associated with increasing dosages.
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Randomized Controlled Trial
A Comparison of Anesthetic Quality Between Interscalene Block and Superior Trunk Block for Arthroscopic Shoulder Surgery: A Randomized Controlled Trial.
Interscalene block is the most commonly used nerve block for shoulder surgery, and superior trunk block has been investigated as a phrenic-sparing alternative. This randomized controlled trial compared ultrasound-guided interscalene block and superior trunk block as anesthesia for arthroscopic shoulder surgery. ⋯ The superior trunk block provided lower quality of surgical anesthesia than the interscalene block and did not effectively decrease the risk of hemidiaphragmatic paralysis during arthroscopic shoulder surgery for rotator cuff syndrome.
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Randomized Controlled Trial
Efficacy of Pulsed Radiofrequency or Short-Term Spinal Cord Stimulation for Acute/Subacute Zoster-Related Pain: A Randomized, Double-Blinded, Controlled Trial.
Postherpetic neuralgia (PHN) is the final stage of varicella zoster infection and a severe refractory neuropathic pain. Hence preventing transition of herpes zoster-related pain to PHN is a very important therapeutic principle for patients at an early stage, especially for older patients.Both pulsed radiofrequency (PRF) and short-term spinal cord stimulation (stSCS) have been proven to be effective to relieve acute/subacute zoster-related pain. However, which treatment could achieve better analgesic effects remains unclear. ⋯ PRF and stSCS are both effective and safe therapeutic alternatives for patients with acute/subacute zoster-related pain, however, stSCS could achieve more pain relief and improvement of life quality compared with PRF.
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Observational Study
Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints.
Sacroiliac joint (SIJ) abnormality is a potential source of low back pain (LBP), therefore numerous patients receive various treatments because of the degenerative changes of SIJ. However, the outcome is unfavorable for patients because these morphologic alterations are common but not the origins of LBP. Previous studies revealed lumbar fusion and transitional vertebra increased the prevalence of degeneration of SIJ. Lumbar disc herniation (LDH) is one of the most common lumbar diseases, but there is no study regarding the relationship between LDH and SIJ degradation. ⋯ The SIJ degeneration in patients with LDH was more serious than in individuals without LDH. SIJ degeneration was more significant in patients with LDH with more pathological alterations, symptoms, and complications. Age and LDH relate to SIJ degeneration. Therefore the diagnosis and selection of treatment for SIJ changes should comprehensively consider the coexistence of LDH.